Individual school policies on administering medication to children vary. There is no legal requirement for teaching staff to give children medicine, even if it’s been prescribed by their doctor. Many schools advise parents to arrange for medicines to be taken before and after school, and at bedtime if possible, but if that’s not an option, with parental permission, schools may agree to give a child medication during school time. 

The teachers’ union NASUWT suggests that schools and colleges employ ‘support staff with appropriate training’ to give medication to children, and make sure that ‘appropriate specialist, external medical support’ is available. That’s an ideal scenario, but perhaps not realistic for all settings.

The Government’s early years foundation stage statutory framework originally stated that “medicines should only be taken to a setting when this is essential, and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse or pharmacist”. This advice led to parents booking unnecessary GP appointments for OTC medicines, and schools refusing to give children everyday medication like antihistamines for hayfever. 

The Department for Education has since confirmed that non-prescription medication can now be administered, as long as parents or carers have given written consent. Pharmacy staff should advise concerned parents that it’s considered a misuse of GP time to take an appointment just to get a prescription to satisfy the needs of their nursery or school, as well as being unnecessary.

According to the National Pharmacy Association: “The amended wording in the statutory framework further clarified that non-prescription medicines do not need a GP prescription before teachers or members of staff can administer them, and what constitutes a non-prescription medicine. Previously, requirements have not been clear enough; schools were asking parents to get prescriptions when not required.”

The wording now allows for both prescription and OTC medications to be given to children at school if needed, but “only where written permission for that particular medicine has been obtained from the parent and/or carer. Providers must keep a written record each time a medicine is administered to a child and inform the child’s parents and/or carers on the same day, or as soon as reasonably practicable”.

Policies in schools still vary, however. Just because a school can legally give a child medication, it doesn’t mean that it will. The National Education Union has told schools to establish their own clear policies and suggests that where pupils are likely to need medical care during their day at school, “an individual health care plan should be drawn up and agreed, from a short, written agreement with parents to a more detailed document requiring the involvement of appropriate health professionals. Such care plans should be reviewed on a regular basis, as agreed with parents.” 

Teaching staff should always be made aware of any medical plans, and it’s especially important they know what to do in an emergency situation.  

Emergency arrangements 

Since 2014, schools have been allowed to keep some medications on their premises for emergency use. This includes things like asthma reliever inhalers. According to figures published by the NHS and Cambridgeshire Community Services, 86 per cent of children find themselves without their inhaler at some point after losing, breaking or forgetting it, or not realising it was empty. While parents are encouraged to make sure their child always has an inhaler, schools can now choose to keep a spare, just in case.

Since 2017, schools have also been allowed to keep a spare adrenaline auto-injector like an EpiPen in case of anaphylactic shock. Parents should still be encouraged to make sure their child carries their emergency medication at all times, but children will be children, and it’s better to be prepared.

Advice for parents and schools

Parents should be advised to take medication for their children into school themselves wherever possible. They should take the smallest possible dose, where that’s practical, and make sure it’s clearly labelled. There are exceptions for liquid medicines, which should be kept in their original bottles.

School staff can refuse to give prescription medicines from packaging that’s been relabelled, rewritten or changed in any way. The name and dose of the drug, the frequency of administration, any likely side effects, and the expiry date should be clearly visible.

Pharmacy teams may be asked for advice by schools about how and where to keep medications. In general, consider this:

• Non-emergency medicines should be kept in a locked cupboard, preferably in a cool place. It’s not a legal requirement, but if they are not locked up, they should be kept somewhere safe that’s known to the child and any relevant staff (e.g the school office or head teacher’s office)
• If the child is capable of managing and carrying their own medicines or devices, they should be kept securely on their person or in a lockable place the child can access easily
• Any medicines that need refrigeration should be kept in an appropriate refrigerator at 2-8°C, with restricted access, in a closed, clearly labelled, plastic container. The temperature should be monitored daily  
• Make sure children know where their medicines are kept and make it easy for them to get access when they need them. If they are kept locked up, the child should always know where the key is or how to access it 
• Emergency medicines and devices like asthma inhalers and EpiPens should be immediately accessible and not locked away
• Controlled drugs must be stored in a locked, non-portable container and only named staff should have access to them. They should still be easily accessible in an emergency. In addition to standard written records, a record should be kept for audit and safety purposes of any doses used and the amount of the controlled drug held.

Schools looking for specific advice on giving medication to children can also refer to the most recent advice from the NASUWT or the most recent statutory guidance from the Department for Education. 

Back to school conditions

As soon as children start mixing after the school holidays, the ‘back to school’ bugs start to appear. Farah Ali, superintendent pharmacist at Perrigo’s Learning Pharmacy, Warman-Freed, in North London, has some tips for pharmacies to pass on to families as children return to school:

• Stay fit and healthy: The healthier we are, the better our bodies can respond and recover when we feel unwell; encourage the whole family to exercise often and to maintain good nutrition
• Plan ahead: Prepare for common health problems by keeping a well-stocked medicine cabinet at home
• Speak to your pharmacist: Pharmacists have expertise to treat many common health problems straight away without the need for a GP appointment.

HEAD LICE

Head lice are common in children, and are nothing to do with dirty hair. Anyone can catch them, but they are extremely common in preschool and primary school children (and families) because of their close person to person method of transmission. Parents will probably notice their child itching and scratching around two to three weeks after coming into contact with someone who has head lice.

Head lice should be treated straight away, and everyone in the house should be treated on the same day. There’s no need to keep children away from school. NHS advice is to try wet combing as the first line of treatment, so pharmacies need to ensure they are fully stocked, ready for the seasonal influx of concerned parents. The wet combing routine - wash hair with ordinary shampoo, apply plenty of conditioner, comb hair from the roots to the ends - is advised for days one, five, nine and 13, with a final check on day 17.

Medicated sprays and lotions should be recommended if wet combing isn’t effective. These should kill the infestation within 24 hours or so, although some treatments need to be repeated a week later. A study commissioned by Lyclear in 2020 revealed that nearly half of parents worry that children will be unwell when returning to school or nursery, and 14 per cent of parents are concerned their children will get head lice. Sander Moeyaert, spokesperson for Lyclear, comments: “Head lice in children is something that can be managed relatively easily. There are simple precautions that can help protect against head lice, including tying up or braiding long hair and reminding children not to share hats or scarves with their friends. Parents should check hair regularly for lice and nits as a precaution.”

SCABIES

Scabies is a skin infection caused by burrowing mites which lay eggs in the top layer of skin. They prefer folded skin (e.g between fingers, wrists, elbows, genitalia and buttocks.) The rash causes tiny bumps and sometimes leads to secondary infection from scratching. Mites spread by direct contact and affected children must be excluded from school until at least 24 hours after the first treatment.

Current NHS advice is to decontaminate bedding, clothing and towels used by the entire household and anyone who has been in close contact with the affected person in the three days before treatment. Everything should be washed in hot water (at least 50^oC) and/or sealed in a plastic bag for at least 72 hours (scabies mites can’t survive more than two or three days away from human skin.) 

Scabies can be treated with permethrin cream or malathion liquid in a formulation designed for scabies (both are also used to treat head lice). The treatment should be applied everywhere from the neck down. Very young children may also need treatment on the scalp. Pregnant or breast-feeding women should seek advice from their GP; babies should also be referred before treatment. A second treatment should take place a week later. Advice for schools is to contact their local Health Protection Team if they have an outbreak.

THREADWORM

Threadworm infection is very common in childhood; worms are usually spotted in stools or discovered when a child repeatedly scratches. They spread very easily and can cause extreme itching around the anus or vagina, particularly at night.

Mebendazole-based medicines – chewable tablets or liquid – should kill off the infestation in children aged two and over. As eggs spread very easily through hands, bedding, clothing and environmental dust, all bedding and towels must be washed at high temperatures. Parents should be encouraged to make sure that children (and adults) wash their hands after using the toilet and before eating, to avoid reinfection. Laundry and regular cleaning should also reduce the risk of re-infection, as should keeping nails short.

Views of the P3pharmacy category panel

“This is a consistent category for each start of term; you can count on it three times a year at least for head lice, threadworm and stocking up on first aid. Head lice is the main focus for many parents and Hedrin is our number one seller. Interestingly, Tubigrip and knee supports do well too; we always stock the small sizes at this time of year. Sadly, we don’t have the space or layout to maximise sales; having a gondola end dedicated to back to school with full point of sale promotions would make a huge difference, I’m sure. It can be a good time to sell off sunscreens, especially is there’s an Indian summer.”

Gareth Evans, Wansford Pharmacy, Peterborough

“As soon as children return to school in September, the requests for head lice products come in, dominating the category – we do get asked about threadworm too. Parents want to know how long to leave products on, what format they should choose. For some, convenience is important; they don’t want a product they have to leave on for hours. Many of the products need to be combed through, so people will ask if a comb is included. Full Marks, Lyclear and Hedrin are our best sellers. More people now come to pharmacy first and GP surgeries refer patients to us. Display at eye level so customers can browse easily.”

Lila Thakerar, Shaftesbury Pharmacy, Harrow

“This is an important category with regular trends and a spike of head lice and threadworm when schools and nurseries start back up´. A common question is whether the child should stay off school; NHS Choices is a good website for answers. In Wales, we can supply products under a PGD through the Common Ailment Scheme. However, for those wishing to purchase, Hedrin is popular for head lice; Ovex is the go-to for threadworm. Ensure you have ample stock when schools start to meet the demand. Cases usually peak and trough quite quickly, so maximise the opportunity so you don’t find yourself directing patients elsewhere.”

Ellis Nugent, Davies Chemist, Gurnos, Swansea